10th National Stroke Conference
IMPACT trial to improve stroke care has
been initiated at four hospitals in Pakistan
Public should be educated about signs and symptoms
of stroke to ensure prevention and early treatment

KARACHI: Pakistan Stroke Society in collaboration with Pakistan Society of Neurology, World stroke organization, Asia Pacific Stroke Organization organized the 10th National Stroke conference at Karachi from October 29-31st 2021. The scientific programme of the conference was spread over numerous sessions which also included plenary talks by speakers from oversees through Video conferencing. Special sessions were devoted to Better Stroke Care, National and International collaboration in stroke care, Global perspective of Stroke, Acute Stroke Care, Covid and Stroke besides pre conference workshops.

Speaking in one of the sessions, Dr. Husnain Shah from Fauji Foundation Hospital Rawalpindi highlighted the role of Safe Implementation of Treatments in Stroke) (SITS). This he said, has a Global scientific impact and has published eighty six articles in major peer reviewed international journals together with 330 authors. Those interested can join SITS which is a non-profit, research-driven, independent, international collaboration. It’s an initiative by the medical profession to assure excellence in acute treatment and secondary prevention of stroke, as well as to facilitate clinical trials. Those interested can register their center and themselves as the local coordinators can register one to several local users, enable preferred SITS data Form and start data entry. First project through SITS International IMPACT trial (Implementing international standards of Practice A low recourse Country by blended Training modules to improve stroke care has been started at four hospitals which includes Fauji Foundation Hospital, PIMS Hospital Islamabad, DHQ Hospitals Rawalpindi and POF Hospital Wah. We should be part of national and international community and we can publish good quality research papers.

Prof. Mazhar Badsha from Islamabad along with Prof. Muhammad Wasay and Dr. Abdul Malik inaugurating the Pharma exhibition during the 10th National Stroke conference held at Karachi from October 29-31st 2021.

Dr. Abdul Malik from Karachi discussed the Stroke Manifesto, what should be done for stroke care in Pakistan. When somebody has a stroke, every second that goes by is crucial. Government should establish stroke prevention programme to educate the public about signs and symptoms, risk factors of stroke and cardiovascular diseases. Thrombolysis with tissue plasminogen activator(tpa) or alteplase has shown to prevent death and disability from stroke, if delivered to eligible patients within 4 to 5 hours. It is estimated that less than hundred people in the whole country currently get this treatment annually. In the teaching /tertiary care institutes there should be round the clock availability of thrombolysis to all stroke patients who come to the hospital time. Telemedicine is rapidly evolving field in acute fortress of delivery of acute stroke care. There are less than fifteen trained stroke specialists in the country with approximately 200 available trained neurologists in Pakistan’s acute care hospitals. At least 35% of stroke and more than half TIA’s are currently misdiagnosed in Pakistan. He urged Government to ensure at least one year Accredited Stroke Fellowship training who have PMC accredited postgraduate neurology medicine degree.

Stroke, Dr. Malik stated does not happen in one day, several modifiable and non-modifiable risk factors bring changes in the blood vessel over a period of several years before the stroke strikes. Government should ban some of the potential stroke risk factors in our society which includes smoking, orally chewed tobacco, Naswar, Pan, mishri ghutka, bajjar and ghundi. Government should formulate a National Stroke Registry which records the number, types and treatment outcomes of patients, assist in planning and evaluation of healthcare and can ensure that patients receive high quality care . Pakistan Stroke Society will assist the Government on the formation and running the registry on professional basis, he added.

Dr. Umer Rashid from PINS Lahore in his presentation said that Pakistan has a population of about 220 million with less than 400 neurologists, around twenty Stroke Specialists while stroke affects one thousand people daily and four hundred stroke related deaths take place every day. There is need for collaboration and areas to work like stroke awareness, stroke identification, risk factor, acute stroke care, post-acute stroke care, rehabilitation, reintegration and care giver support. Without Neurologists Stroke units cannot be run. We also have to collaborate with internists, family physicians, ER Physicians, radiologists, interventionists, Radiologists, cardiologists, and others. Awareness among doctors about how to treat stroke is a major issue, he added.

A Group photograph of the participants of 10th National Stroke conference photographed with
organizers and some speakers of the conference.

Dr. Ismail Khatri from Saudi Arabia discussed the spectrum of stroke care its need for collaboration, who to collaborate with and what to achieve with collaboration. He was of the view that we need to collaborate in education about stroke to the community and healthcare providers, Standard of care and quality monitoring. Our target should be to achieve stroke risk factor identification, stroke prevention, primary prevention, secondary prevention and post stoke complication care. Our efforts should be to improve social services with the help of community organizations for prevention of stroke, unified access to stroke care, research and development, healthcare quality and performance improvement and health care cost. We need to think of people for whom we can collaborate with Pharma industry to help in education of community and health care providers and to invest in research and development which will reduce the cost of treatment.

Dr. Mansoor Osama from Egypt talking abbot MENA-SINO stroke initiative said that setting up something new is often challenging, particularly if it involves changing the existing routine that people have become used to. The challenge can be particularly daunting when it comes to developing a new clinical service in a modern healthcare system. This is rarely more so than in setting up an acute stroke service. Time is the most important factor in the multidisciplinary management of stroke. Cost effectiveness can only be achieved if the door to treatment time remains as short as possible in order to increase the chance of a positive outcome. Setting up link between all stakeholders and keeping them always involved was essential. Training programme in acute stroke diagnosis and therapy need to be established for physicians, radiographers and nursing staff. We should educate public through awareness campaign besides Setting up quality metrics to keep the process cost effective, he added.

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